Which Medicaid Insurance Is Best


Tip #: Know Where To Go


It’s not always obvious where to look for health insurance. “In this country it is a truly wacky patchwork quilt of options,” says Sabrina Corlette, who co-directs the Center on Health Insurance Reform at Georgetown University.

If you’re 65 or older, you’re eligible for Medicare. It’s a federally run program the government pays for much of your health care. You might also be eligible if you have certain disabilities. For those already enrolled in Medicare or in a Medicare Advantage plan, the open enrollment period to switch up your supplemental health and prescription drug plans for 2022 runs through Dec. 7 this year.

For those under age 65, Corlette says, “the vast majority of us get our coverage through our employer. The employer typically will cover between 70% and 90% of your premium costs, which is pretty nice.” Check with your supervisor or your company’s human resources department to find out what, if any, plans are available to you through your job.

Is Your Doctor In

Medicaid plan providers utilize a ânetworkâ of doctors, hospitals, and medical care providers, and checking to see if your doctor or care provider is within the Medicaid network is important before making your final decision on a plan. Most Medicaid plans cover the cost of routine check-ups, doctorâs visits, emergency room costs, and other related expenses as long as the healthcare providers are within the Medicaid network.

Is A Medicare Advantage Plan Worth It

It is worth it to get a Medicare Advantage plan, especially if you can find a plan with a $0 premium. Some of those plans have higher out-of-pocket costs or copays , but it would likely be far less expensive for you in the long run versus Original Medicare, especially since Original Medicare would require an extra plan to include prescription medications and has no cap on out-of-pocket costs.

Bundling usually makes sense, and most of the plans reviewed here also include âextrasâ such as vision, dental, and hearing, all for the same premium. Itâs less to keep track of and more coverage for less money .

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Best States For Medicare: Overview

In this report, we determine where Medicare beneficiaries have access to the widest range of quality private Medicare plans at the most affordable prices. To do this, we compared plan data from the Centers for Medicare & Medicaid Services for the 50 states, using two primary factors:

  • AffordabilityWe factored the average premium, average annual drug deductible and average in-network max out-of-pocket spending limit.
  • QualityWe highlighted the percentage of plans that are ranked four stars or higher based on the Medicare Star Rating system.1 All Medicare Advantage plans and Medicare Part D drug plans are assigned an annual star rating by the Centers for Medicare & Medicaid Services . One-star plans are determined to be lowest quality, and plans rated four stars or higher are considered top-rated plans.

Read on for our findings and for expert insight on the future of Medicare in America.

What Are The Ratings

Medical Insurance And Medicaid And Stethoscope Stock Photo

Ratings provide insight into a companys financial strength and its reputation with customers. To evaluate insurers financial strength ratings, we checked with credit rating provider AM Best.1 For insight into customer service, we looked to the National Committee for Quality Assurance ,2 the American Customer Satisfaction Index , and rating company J.D. Power. We turned to the National Association of Insurance Commissioners Complaint Index to understand customer complaints.

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Medicare Supplement Plans In Massachusetts

Like we mentioned above, Medicare Supplement Insurance plans are structured differently in Massachusetts. Residents of the Bay State only have two plans to choose from: the Core Plan and the Supplement 1 Plan.

  • Coinsurance for Part A services plus 365 additional hospital days

  • Coinsurance and copayments for hospice costs under Part A

  • Coinsurance for medical services under Part B

  • First three pints of blood

Screenshot from “Choosing a Medigap Policy,” July 8, 2019.

Additionally, both plans cover state-mandated insurance benefits, such as annual Pap smears and mammograms. A full list of mandated insurance benefits can be seen here. The state government establishes maximum benefit amounts for some of these benefits. You can find complete plan details for 2019, along with plan premiums, on this link.

In addition to the basic benefits and mandated benefits, the Core plan covers 60 days of hospitalization in a mental health facility. It does not cover any deductibles for Medicare Part A or Part B.

Best for: People who can afford their Part B deductible, especially those who do not have a history of mental health hospitalizations and who do not foresee a need for nursing home or inpatient care. Depending on the insurer, premiums for the Core plan can be much lower than the Supplement 1 plan.

When Is Open Enrollment For Health Insurance For 2021

The open enrollment period for health insurance depends on whether you’re buying a Medicare plan, a policy from an employer, or an option from the HealthCare Marketplace.

The enrollment period for the HealthCare Marketplace runs from Nov. 1, 2021 to Jan. 15, 2022 for coverage in 2022. If you want coverage for Jan. 1 you must enroll by Dec. 15. Otherwise, your coverage will begin on Feb. 1. The enrollment period for those newly eligible for Medicare is a seven-month window after turning 65. After that, the annual enrollment period is from Jan. 1 through March 31 each year.

Those who buy insurance from an employer should ask their HR department about the enrollment period because private companies can set their own deadlines.

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Do You Have A Health Condition That Must Be Covered

Different Medicaid plans cover different health conditions, and while most New York Medicaid providers offer standard care for most common ailments, if you have a specific condition that needs to be addressed itâs worth investigating to see if your desired provider covers that condition.

For example, if youâre pregnant , have a mental disability, or face behavioral issues, itâs important to check and make sure that your plan covers the specific expenses related to these situations. Some Medicaid providers offer specialized Medicaid plans for different situations like these, so be aware.

How Much Does Health Insurance Cost

Is Medicaid Coverage Better or Worse than Private Insurance?

Health insurance plans can vary greatly in cost based on factors such as your health, your geographic region, the amount of your deductible, and copay requirements. Its a good idea to compare the total costs and benefits of the plan and not just look at the premium.

Policies with lower deductibles generally allow you to pay less upfront, but youll pay a higher monthly premium in exchange for that. Youre effectively paying more on a monthly basis rather than all at once through a deductible when you need care. You might also be responsible for a co-pay, a fixed percentage of the balance remaining after youve paid your deductible. You and the insurance company are sharing the costs.

Health insurance you might receive through your employer is typically cheaper than purchasing a policy on your own.

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Best Set Pricing: Aarp

  • Must join AARP to enroll

  • Need birthday and current Medicare information for price details

  • No link to Medicare Supplement coverage from the main website

AARP is a nonprofit, nonpartisan membership organization that helps people who are ages 50-plus with a variety of services and information. One of the most trusted names for retirees and other seniors, the organization boasts 38 million members and is insured through UnitedHealthcare, which earns an A rating from AM Best for financial strength.

We chose AARP as best for its set pricing for Medicare Supplement coverage because it doesnt charge more as you grow older. This is especially helpful if you are still covered under your employer’s insurance and may require coverage after the age of 65.

AARP covers Parts A, B, C, F, G, K, L, and N, though its important to note that plans C and F are only available if you were enrolled in Medicare before January 2020. You can get pricing information easily by entering your ZIP code, and there’s a Spanish language website as well.

Compare Medigap Plan Costs

Deductible, coinsurance and copayment coverages are standardized between companies. However, the monthly price may vary greatly between companies depending on your age, where you live and discounts. To make sure a plan is financially beneficial, multiply the monthly premium by 12 and add any out-of-pocket cost you may need to spend. Weigh that cost against the chance youâll spend more than that amount on health care if you do not have supplement insurance.

  • Monthly premium: Monthly premiums for the same types of policies vary from insurer to insurer, so you should get multiple quotes before choosing a policy.
  • Discounts: Some companies offer discounts for paying your premium in full annually, paying electronically, being married or being a nonsmoker. Consider getting quotes from companies you already have policies with, and ask the agent if discounts exist for current customers.

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What Are The Benefits Of Buying A Medicare Supplement Plan

The benefit of a Medicare Supplement plan is that it pays for the costs that are not paid for by Original Medicare. These include coverage for prescription medications, hospital stays, hospice care, bloodwork, and emergency room visits. It can drastically limit the out-of-pocket expenses that you may be hit with.

How Do Medicare Supplement Plans Work

How to Apply for Medicaid

Medicare Supplement Plans are designed to pick up the slack where Medicare payments leave off. Medicare Supplement policies are standardized by the federal governments. This means that the benefits of each policy are the same, regardless of which company you select to purchase your policy from. The only real difference is what type of policy each company offers, the prices charged, and how the company determines rate increases. You can keep your own doctor with Medicare Supplement policies.

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Best Medicare Advantage Providers Ratings

  • Over-the-counter drug coverage
  • Other services that promote health and wellness

You cant be enrolled in a Medicare Advantage plan and Original Medicare at the same time. To obtain Medicare benefits youve earned through payroll deductions before retirement, you must choose one of these plans.

During the open enrollment period, which runs from Oct.15 to Dec. 7 each year, you can join, switch or drop a plan for your coverage to begin on Jan. 1. If youre already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or Original Medicare during the Medicare Advantage open enrollment period, which starts on Jan. 1 and ends on March 31 annually. You can only make one switch during that time period.

If youre already enrolled in Original Medicare , you may be eligible to switch to a Medicare Advantage plan . You must be at least 65 years old or have certain disabilities, such as permanent kidney failure or amyotrophic lateral sclerosis . If the Medicare Advantage plan you choose doesnt already have prescription drug coverage, you will have the option to enroll in Part D.

Dont Pay For What You Dont Need

“The biggest mistake people make is not reevaluating their healthcare coverage for the coming year,” says Murdoch. And yet, in a 2019 government survey, more than 7 in 10 Medicare beneficiaries said they did not shop around for plans the previous year.

“People tend to assume that if their plan is working for them, it will be perfectly fine for the next year, says Murdoch. In reality, plans change from year to year. Premiums can go up, doctors and specialists may depart from provider networks, and deductibles and copays can increase.

Most important for people with Part D coverage, especially if they take expensive medications: Drugs can be removed from formularies. Prescription drugs may move from a lower pricing tier to a higher one, raising your out-of-pocket cost for each refill. Giving your Part D plan a hard look each year can save you from surprise price hikes.

Over the years, Medicare “choice errors” can add up to hundreds, or even thousands, of lost dollars. Researchers cited by the National Council on Aging calculated how much Medicare Advantage enrollees paid in premiums and out-of-pocket costs. They then compared that total to each persons estimated benefit. The greater the mismatch, the greater the choice error. They found that many people pay too much for the benefits they get, and that, even so, they rarely switch plans. Worse, notes the NCOA, the magnitude of these choice errors can actually increase over time.”

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Best For Bonuses: Aarp

AARP Medicare Advantage plans include extra benefits, from dental, vision, and hearing, to over-the-counter benefits and fitness programs. AARP offers lots of additional support to help members stay healthy or manage health conditions.

  • Plenty of added bonuses, like annual ear/eye exams and $0 copay dental work

  • Low copays and prescription drug copays

  • Automatic deduction from Social Security benefits available

  • No mobile app for payments

  • Higher out-of-pocket maximums

Nearly all of the Medicare Advantage plans offered by AARP come with plenty of extras, such as dental exams, vision and eyewear coverage, and foot coverage. There is also Renew Active, a Medicare fitness program with a gym membership, and an online brain health program.

AARP offers low copays for specialist visits, like oncologists or cardiologists, provided theyâre in-network, and a variety of Medicare Advantage plans . It also has an incredible amount of detailed educational information about Medicare and Medicare Advantage plans on its website, including the option to receive a free Medicare guide via email. However, the out-of-pocket maximums can be a bit on the high side, usually several thousand dollars.

Holdout States Haven’t Expanded Medicaid Leaving 2 Million People In Limbo

Feds issue new standards for Medicaid insurance plans

Then there’s Medicaid, the health insurance program for people with low incomes, that covers around 80 million people nearly one in four Americans. It’s funded by both the federal and state governments, but run by each state, so whether you’re eligible depends on where you live.

For practically everyone else, the place to go is Healthcare.gov, where you can shop for insurance in the marketplaces created by the Affordable Care Act, also known as Obamacare.

This is where you look for health insurance if you don’t fit any of the categories we mentioned previously, Corlette says if, for example, “your employer doesn’t offer you any coverage you’re not eligible for Medicare because you’re not old enough and you’re not poor enough for Medicaid. You can go to the marketplaces, apply for financial help depending on your income, and choose a plan there.”

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What Can I Expect To Pay For A Medicare Supplement Plan

According to eHealth Medicare Insurance, the average Medicare Supplement premium in 2019 was $152 per month.

Note that it is difficult to estimate an average cost for a Medicare plan because there are so many variables that can dramatically impact the cost.

Whether the company offers insurance rates based on age/gender or not, there are several types of policies, including:

  • Community-rated: The same premium is charged to anyone who is approved for the Medigap policy, regardless of age or gender.
  • Issue-age-related: The premium is based on age when you purchase the policy.
  • Attained-age-related: The premium is based on your age at the present time and goes up as you get older.

Other factors that often impact costs include:

  • The type of policy purchased
  • Whether you are buying the insurance during your Medigap Open Enrollment Period
  • What state you live in
  • Your health condition
  • The type of discounts offered by the company
  • Your age

Molina: Best Health Insurance Company For Small Budgets

Reasons to avoid

Molina Healthcare is generally very well regarded thanks to its focus on helping underserved populations and lower-income customers. It also runs good wellness services that complement its healthcare offerings, with discounts on weight loss and smoking cessation programs, for example.

Molinas insurance is available to residents of 15 states, meaning that the network is slightly more limited compared to nationally-available polices. However, premium levels of customer satisfaction levels make it an attractive proposition where it is available. Molina operates a number of physical clinics and health centers in the states where it does operate.

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Consider Talking To A Broker Or Consultant

Programs such as the federally funded State Health Insurance Assistance Programs are excellent resources. Working with a broker has a lot of benefits, including experience and connections with a huge array of insurance companies. Many brokers maintain an ongoing relationship with you to help you as your needs change.

There are very specific rules to protect you regarding brokers, so keep these in mind as you reach out and research.

Do not pay a Medicare broker directly for their assistance. They are paid by the insurance company to sell their insurance. If you suspect Medicare Advantage fraud, please call the Medicare Drug Integrity Contractor at 1-877-772-3379.

Best Medicare Advantage Plans: Kaiser Permanente

Healthfirst Insurance Medicaid

Insurer details

  • AM Best Financial Strength Rating: Not rated
  • NAIC complaint index 0.39
  • Unique value: Access to Kaiser’s medical centers and doctors

Kaiser Permanente offers top-rated individual health insurance options in eight states: California, Colorado, Georgia, Hawaii, Oregon, Washington state, Maryland, Virginia and Washington, D.C.

But the company is best-known for its Medicare Advantage policies where its streamlined health care access leads to a high quality of care. The company has consistently been the best insurer in the J.D. Power survey of Medicare Advantage customer satisfaction. This rating, combined with the high NCQA star rating, shows that the insurance company stands out for both its policies and its customer-first approach.

The downside is that enrollees have a limited provider network. Rather than having access to a wide range of medical providers, the insurer pairs its insurance with its medical facilities, making these plans less than ideal for those who prefer flexibility.

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